Central Texas College

Student Forms
Formal Complaint - Student

Electronic submission of this form indicates all information contained herein is true and correct.

* NOTE: All fields are required; if "Not applicable," enter NA.

Central Texas College

COMPLAINT FORM

YES, I have attempted to resolve this complaint informally with the party/parties involved as outlined in the CTC Student Handbook.

 
Date Submitted:

YOUR Name:



























I AM:



 
LOCATION:




 
COMPLAINT PERTAINS TO:






COMPLAINT NARRATIVE/ALLEGATIONS
(WHAT HAPPENED and WHEN?)
State your complaint:

Be as descriptive as possible; include specific information.
  • Date of incident
  • Names of all persons involved
  • Direct quotes of any conversation/s
STEPS ALREADY TAKEN TO RESOLVE THE ISSUE
(WHAT SPECIFIC STEPS HAVE YOU TAKEN TO DATE TO RESOLVE THE ISSUE?)
What steps have you already taken to resolve the problem?
  • List names of who you have already spoken with
  • Provide pertinent times/dates of conversation/s
  • Direct quotes of any conversation/s
DESIRED/EXPECTED COMPLAINT RESOLUTION
(WHAT ACTION/S WOULD YOU LIKE TO OCCUR AS A RESULT OF YOUR SUBMITTING THIS COMPLAINT?)
State your desired/expected resolution.

Provide specific action/s you would like to occur as a result of filing this complaint.

I understand that submission of this form serves as my signature and certify that the contents being submitted are true and accurate.